b'NSAIDs Might Be Associated WithImproved Survival in ICI-Treated NSCLC Immune checkpoint inhibitors have played a major role in the increased survival of patients with NSCLC. Now, a new study involving veterans has raised the possibility that common painkillers, nonsteroidal anti-inflammatory drugs (NSAIDs), could play a role in further lengthening survival rates in lung cancer patients being treated with ICIs.By Mary Anne DunkinATLANTAFor veterans, the rate of lung cancer isVHA Corporate Data Warehouse to identify patients even higher than for the general population, accord- whowerediagnosedwithNSCLCbetween2010 ing to the VA. Nearly 8,000 veterans are diagnosedand 2018 and treated within the VA system.They and treated in the VA for lung cancer each year. Anstratified patients between those with concomitant estimated 900,000 are at risk for lung cancer due toNSAID usedefined as NSAID dispensation by a age, smoking and environmental exposures duringVA pharmacy within 90 days of any ICI infusionandaftermilitaryservice.Forveteranswithlungand those without. Survival was measured from the cancer, the rate of survival also is lower than for thestart of ICI.general population.Although the advent of immune checkpoint inhibi- Overall Survivaltors (ICIs) has led to substantial improvements inThe researchers then used various statistical analyses lungcancersurvivaloverthepastdecadepar- to compare the survival of the two groups, Sebastian ticularlyinpatientswithmetastaticandlocallysaid. In total we identified 3634 veterans with non-advanced non-small cell lung cancer (NSCLC)notsmalllungcellcancerandclosetotwo-thirdsof all patients respond to the drugs. And the majority ofthem were treated with NSAIDs. Those treated with those who do eventually have disease progression,NSAIDs had a higher number of medical comorbidi-possibly due to development of tumor resistance toties and in general were sicker patients, he said. Yet, further immune blockade, said Nikhil T. Sebastian,interestingly they had overall survivala mean of MD,assistantprofessorofradiationoncologyat10 months as opposed to eightcompared to those Emory Winship Cancer Institute in Atlanta and firstwho didnt receive NSAIDs. Results were published author of a new study suggesting the use of non- in the journal Clinical Lung Cancer.steroidalanti-inflammatorydrugs(NSAIDs)mayWhen the researchers stratified NSAIDs by indi-prolong survival in NSCLC patients taking immunevidual subtype, diclofenac was the only one that had checkpoint inhibitors .1 astatisticallysignificantassociationwithoverall Our group is interested in identifying drugs thatsurvival, Sebastian said, noting that the study wasnt caneasilyberepurposedwhicharewelltested,designed to study individual NSAIDs. We didnt widelyavailableandaffordabledrugsthatcouldhave enough patients per group, but it is an interest-potentially enhance these immune checkpoint inhib- ing correlation nonetheless, he said.itors, he said. The theoretical rationale for why NSAIDs in gen-InthejointstudyoftheAtlantaVAMCanderal work is that they block cyclooxygenase, said EmoryUniversitysWinshipCancerInstituteandSebastian. Preclinical studies suggest that cycloox-Morningside Center for Innovative and Affordableygenase-dependent pathways mediate tumor growth Medicine,Sebastianandhiscolleaguesusedtheand evasion of immunity. So blocking this enzyme Continued on Page 104 u102'